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Kategorie: Paula Caplan

The Great “Crazy” Cover-up: Harm Results from Rewriting the History of DSM

I have been immersed in the field of psychiatric diagnosis – and resistance to it – for more than a quarter of a century. In the late 1980s, I was a consultant to two committees appointed by DSM-IV Task Force head Allen Frances to decide what DSM-IV should contain. I resigned from those committees after two years because I was appalled by the way I saw that good scientific research was often being ignored, distorted, or lied about and the way that junk science was being used as though it were of high quality . . . if that suited the aims of those in charge. I also resigned because I was increasingly learning that giving someone a psychiatric label was extremely unlikely to reduce their suffering but carried serious risks of harm, and when I had reported these concerns and examples of harm to those at the top, they had ignored or even publicly misrepresented the facts. I wrote about what I learned from my insider’s position in my book, They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal (Caplan, 1995).

From about 2009 until DSM-5 was published in 2013, there was massive coverage in popular and professional media about outcries against DSM-5. The outcries were largely based on the assumption that it would represent a break with DSM-IV (published in 1994 and minimally altered for a 2000 edition), which was seriously misrepresented as having been solidly scientific, helpful, and – for all but a tiny number of its hundreds of categories –  not harmful.  The rewriting of history has continued in publications since DSM-5 appeared, so that there has been a massive and damaging rewriting of history, and it lends a legitimacy to DSM and other diagnoses in general, when, in fact, the recurring problem is that psychiatric disorders have never been validated, in fact not even shown to be reliable.



DSM-5 Could Be Hazardous to Your Mental Health

by opednews

Ava C., adopted from Asia and raised in small-town America, knew she looked different than her classmates, but no one ever talked about her origins. Over time, she began to withdraw.   Following a psychiatric diagnosis of depression, she thought of herself as „mentally ill.“   One day, while in a major city’s bustling Chinatown, she realized, „All around me were people who looked like me, doing ordinary things.   They apparently didn’t feel „sick.‘ That’s when my depression lifted.“

People like Ava — from different cultures, classes, races, or genders — often experience life’s stresses in unique ways. Too frequently they are labeled ill or abnormal by the psychiatric establishment.

Dr. George Albee, Emeritus Professor at the University of Vermont, once noted that „the highest rate of „idiocy and lunacy‘ in America was first among the millions of immigrant poverty-stricken Irish after the potato crop failure of 1845, then on successive waves of poor Swedes, then Slavs and Russian Jews, then Southern Italians, now Blacks and Hispanics“as each group achieved economic success their incidence of „idiocy and lunacy‘ fell to the population average.“

As the new Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is released this year, experts are sounding cautionary notes.   Among the „psychiatrist’s bible“ critics is Dr. Paula J. Caplan, a feminist psychologist who served as advisor to two DSM-4 committees before resigning due to concerns about „how fast and lose they play with the scientific research related to diagnosis.“   Caplan has become the leading voice in alerting therapists and the public to the manual’s „unscientific nature and the dangers that believing in its objectivity poses.“

„It is widely believed „that if only a person gets the right psychiatric diagnosis, the therapist will know what kind of measures will be most helpful.   Unfortunately, that is not usually the case,“ Caplan says. „Getting a psychiatric diagnosis can often create more problems than it solves, including difficulties with obtaining health insurance, loss of employment, loss of child custody, the overlooking of physical illnesses“and the loss of the right to make decisions about one’s medical and legal affairs.“

Caplan worries that the authors of the DSM make „expansive claims about their knowledge and authority, wielding enormous power to decide who will and will not be called mentally ill and what the varieties of alleged mental illness will be.“   She doesn’t deny that psychotherapy and medication can be helpful, but she sees worrisome connections between „drug companies‘ concealment of the harm their products can cause and some professionals‘ pushing of particular drugs while on the payroll of pharmaceutical companies.“

The American Psychiatric Association (APA), which writes the DSM, says its purpose is to establish criteria for diagnosis and „not to create medical conditions out of the full range of human behavior and emotions.“   It also claims to be dedicated to „ensuring that the development of DMS-5 is the most open and inclusive in the history of the manual.“

Still, Caplan remains concerned about the „shroud of secrecy“ that she sees enveloping the process.   As director of the Coalition for Informed Patients and Doctors, she has called for Congressional hearings about psychiatric diagnosis „in an attempt to explore the nature and extent of harm that many Americans have suffered solely because of being given a psychiatric label.“

Feminist therapists are concerned for women in particular. Diagnoses such as Borderline Personality Disorder (BPD) and Sexual Dysfunction have disparaged women and compromised them in troubling ways. For example, one expert says that BPD is almost exclusively applied to women because its symptoms relate to emotion and anger.   Some women with the diagnosis have histories of abuse and may have difficulty expressing anger „appropriately.“   Such vulnerable women need to have their coping styles better understood before assumptions are made about their behavior.

Similarly, „sexual dysfunction“ among women is often based on assumptions about what constitutes normal sexual behavior.   „If only performance failures or lack of desire count, the entire context of sexual activity becomes invisible and of secondary importance,“ says one member of the Association of Women in Psychology (AWP).

Another AWP member focuses on classism in psychiatric diagnosis.   „Poor women and women of color are particularly likely to be misdiagnosed or encounter bias in treatment,“ she says. „Therapists may interpret chronic lateness or missed appointments as hostility or resistance to treatment rather than the outcomes of unreliable transportation, irregular shift work, and unpredictable child care arrangements.“

Caplan and her colleagues warn that „the absence of science creates a vacuum, and biases and distortions rush in.“   Serious problems like depression are overlooked as people are diagnosed with unproven „mental illnesses‘.    „Many people who are suffering because of social problems like poverty or because they are victims of hate speech or violence are wrongly treated as though the problems come from within them.“

That’s enough to make anyone call for hearings instead of professional help.

Paula J. Caplan and the “DSM 9” call upon the APA to stop the harm of psychiatric diagnosis

Paula J. Caplan, dissident psychologist and human rights activist, is working with a group of psychiatric survivors and allies to officially call upon the American Psychiatric Association [APA] to stop the harm that often results from psychiatric diagnosis.

Paula J. Caplan and the “DSM 9” call upon the APA to stop the harm of psychiatric diagnosis  Jenny McClendon, one of the DSM 9, has told her story of harm by psychiatric diagnosis in an official complaint to the APA and on YouTube.

The group, popularly known as the “DSM 9,” filed 9 official complaints with the ethics department: 7 of them were by people who themselves were harmed by diagnosis, the 8th was one whose brother who had died from diagnosis, and the 9th was from Caplan herself.

The APA’s response was an abrupt dismissal.

Says Paula, “The APA summarily dismissed all 9 complaints in one short, strange paragraph.  They never even told us who the members of the ethics committee are – it’s like a secret society! They did not address the content of the complaints, [dismissing them] on spurious procedural grounds.”

Caplan and Jenny McClendon, a military veteran who is a complainant, went with activist Leah Harris and social worker Debra Turkat to the building that houses APA headquarters on November 13th in an attempt to meet with the ethics department’s administrative head and the APA’s general counsel about dismissal of the claims. They were ejected from the building  after being prevented from entering APA offices.

The importance of challenging psychiatric diagnoses

Paula J. Caplan’s and the DSM 9’s actions, like those of MindFreedom International at OCCUPY THE APA, are aimed at drawing public attention to the harm that psychiatric diagnosis — a subjective process that is presented by the APA as both scientific and definitive — can cause.

The group wants to send 3 main messages to the general public about psychiatric diagnosis:

  1. It simply is not scientifically grounded.
  2. It does not help improve outcomes (doesn’t reduce human suffering).
  3. It carries enormous risks for the individual so labeled.

Paula Joan Caplan, PhDSays Paula (pictured at left), “The ultimate aim is to get professionals and the public to stop assuming that what’s most needed is to know what the person’s diagnosis is. What’s most needed is to listen to what happened to the person and to find ways that help.”

“People need to have a respectful listener, who will bear witness to what they’ve been through…who can present not just medications or even psychotherapy, but the whole range of things that have been shown to help people. Things that are low risk and non-pathologizing.  For example: meditation, having a friend, volunteer work, physical exercise, political action, arts, community work, having a service animal.  An amazing number of things can help people heal!”

The APA Refuses to Listen to Voices of People Harmed by Diagnosis … and Refuses and Refuses and Refuses

by Paula Caplan

When you try to speak truth to power, what happens if the powerful turn off their hearing aids?

These days, when I think of the American Psychiatric Association (APA), I remember Lily Tomlin’s character Ernestine, an obstreperous telephone operator who was damned if she was really going to help anyone who needed it. Emitting her snorting laugh, she would say, “We don’t care. We don’t have to. We’re the telephone company.” The APA doesn’t care. It doesn’t have to. It is totally unregulated. That makes it even less regulated than the financial giants who have so damaged the economy.

I write today’s essay as part of a larger, ongoing set of actions for public education, because the people need to know how utterly unresponsive and cold-blooded this unregulated lobby group is. We know something about what happens to an individual whose destructive actions are completely unchecked. The APA’s fortress protects 36,000 psychiatrists, and although some I know personally and consider great human beings and helpers, the organization’s power and the cover of its so-called ethics rules provide protection for those who break the “Do no harm rule.” In fact, the APA’s motto might well be, “We will allow no harm to be done to our members who do harm to those who come seeking help.”

On October 1, I reported here ( that nine groundbreaking complaints about psychiatric diagnosis destroying people’s lives had been filed three months before with the American Psychiatric Association’s Ethics Department, because the APA creates, markets, and profits from the Diagnostic and Statistical Manual of Mental Disorders, while promoting the false beliefs that its contents are scientifically-grounded and likely to help reduce suffering, as well as that they carry no risks of harm.

The heart of each document was an eloquent description of the kinds of harm that its writer had suffered. Together, the women described the losses and damage of every imaginable kind that they had suffered. Each one listed a number of requests for action that would redress the harm done to them individually and prevent harm to others in the future.

In my November 11 essay (, I announced that on October 22, 2012, in one brief and strange paragraph sent simultaneously to all nine, the APA summarily dismissed the complaints, giving not the slightest indication that they had even considered their merits. At no time did anyone from the APA respond to our request that they bring in objective people from outside the APA to handle the complaints, rather than handling them within the APA. We had pointed out that, especially because the APA itself was named as a respondent in our complaints, it would be important to do this in order to avoid conflicts of interest or even the appearance of conflicts of interest.

The November 11 essay contains the heartbreaking and infuriating story of Jenny McClendon, a military veteran who was repeatedly raped while serving in the Navy, and then, when she sought help, was diagnosed first with Bipolar Disorder and later with Borderline Personality Disorder and told that her mental illnesses were what caused her upset. It was appalling that all of the complainants’ pleas to be heard were dismissed, and you can imagine how the dismissals caused the complainants pain, rage, and feelings of yet again being treated as though their suffering did not matter…but what special irony that the news came to Jenny shortly before Veterans Day.

I want here to (1)describe what was in that paragraph of dismissal, (2)tell you the response to it that I sent the APA, (3)describe some related efforts made with regard to the complaints, including a visit Jenny McClendon and I made to APA headquarters on November 13, and (4)tell you a number of ways that you can help.

The APA’s notice of dismissal
On October 22, 2012, the following brief, strange notice of the summary dismissal of the complaints was sent from to all nine complainants simultaneously:

Dear Complainants:
The APA Ethics Committee met and reviewed the complaints that you filed.  After thorough discussion, the unanimous conclusion of the Committee is that none of the complaints filed comply with APA’s procedures for filing and resolving ethics complaints, and in any event, none of the complaints state a violation of the Ethics rules against the respondents named in the complaints.  Instead, the complaints reflect a fundamental misunderstanding on your part of the purpose and appropriate use of DSM-IV in diagnosing mental illness.  Since you filed these complaints with the APA Ethics Committee rather than with a district branch, there is no further appeal from this Committee’s unanimous decision and these cases are closed.
The APA Ethics Committee

Some of the complainants wrote that — though not at all surprised — they felt variously erased, helpless, abused, ignored, and enraged.

Dismissal of the complaints had always seemed what the APA would be most likely to do, but the brief paragraph of dismissal was striking in that they relied solely on procedural grounds and provided neither adequate clarity nor justification of those grounds.

Response to the notice of dismissal
I emailed the complainants to suggest that we take some time to think how to proceed before publicly announcing the dismissal. Unfortunately, I unthinkingly hit “Reply All,” and since the notice of dismissal had been copied to Linda Hughes, who appears to be the head administrator of the APA’s Ethics Department, it also went to her. In that message, I referred to a “November 12 action” that was planned and said that I thought that in addition to asking for an in-person meeting with the APA people, we should now also plan to ask them to explain the grounds they cited for dismissal. You will see later how that may have become relevant, but I sent out another message to the complainants, copied purposely to Hughes, in which I said that I had meant to refer to the planned November 6 action.

On November 2, I sent an email in response to the letter of dismissal, variously challenging what they had written, asking questions about it, and making six requests. When you read my question (5), you will need to know that we filed the complaints against a great many respondents, aiming to include all who had major responsibility for the DSM edition that had caused harm to the complainants. That included not only the top DSM-IV and IV-TR people who remain APA members but also everyone who had been an APA president or member of the board of trustees from 1988 (when work on DSM-IV began) to the present and the entity that is the APA itself, because the organization is listed as the publisher of the manual, oversees the advertising, and reaps the profits from it. We argued that each respondent knew or ought to have known the truth about the manual and could have reduced the harm by making sure that the truth would be publicly known. Instead, each either did nothing of the kind or made public statements that the manual is scientific and/or helpful and failed to warn of or try in any way to document, prevent, or redress the harm.

The APA’s description of procedures for filing complaints includes a statement that a complaint can be filed with a district branch and that a complaint filed with the APA itself, the complaint will be referred to the district branch of what they call the “Accused Member.” We filed our complaints with the APA itself and specifically asked that they be dealt with at the national level, both because the respondents live in so many different district branches and because the matters addressed in the complaints are of national (even international) import. If you read my first essay in this space about the complaints (, you know that in the months after we filed, emails from APA Ethics Department head Linda Hughes and General Counsel Colleen Coyle made it clear that they were trying to find ways to dismiss the complaints without considering their merits, and one way was to assert that their procedures did not allow for consideration at the national level. Coyle had stated that in order to be fair to other complainants, they had to use the same procedures with us, including assigning ours to district branches. I had responded to her that as an attorney, she would recognize that the history of the legal system in the United States shows that there are times when circumstances warrant major changes and that if the courts had not considered such changes important, then slavery would still have been legal, and she and I would not be allowed to vote. This argument carried no weight, because the APA’s determination to dismiss the complaints overrode their willingness to consider what really matters. How troubling that it was the APA’s division charged with ensuring ethical conduct that made this determination.

Here is my November 2 email:

Dear Colleen Coyle, Linda Hughes, and “Ethics Committee”:

On behalf of all nine of us complainants, I am writing to ask the following, and we hope you will do us the courtesy of sending replies:

(1)In the brief note you sent on October 22, 2012, you said it was “the unanimous conclusion of the [Ethics] Committee” that the complaints should be dismissed. We ask yet again that you tell us the names of the members of that committee. Does it not strike you as rather medieval for the committee members’ names to be kept secret from the complainants, especially given that these are the people whom the APA entrusts with ensuring that its ethical rules are followed? In the absence of this information, you are telling all of these people whose horrible suffering is documented in their complaints that some undisclosed number of secret members have summarily decided the fate of their request for fair consideration.

(2)In the October 22 note, you allege that “none of the complaints filed comply with APA’s procedures for filing and resolving ethics complaints.” Only the sparsest guidelines for filing a complaint are given in the materials you make available online to people wishing to file complaints (at under “PROCEDURES FOR HANDLING COMPLAINTS OF UNETHICAL CONDUCT,”) but all nine of us followed those guidelines. Therefore, we ask that you tell us specifically which procedures any of the complainants failed to meet.

(3)In the October 22 note, since your statement that “none of the complaints state a violation of the Ethics rules against the respondents named in the complaints,” but that is simply and patently untrue — Section 1 and the lengthy Section 3 in each complaint stating precisely that — we ask that you tell us what basis you use for ignoring all of that material.

(4) In the October 22 note of dismissal, you allege that “the complaints reflect a fundamental misunderstanding on your part of the purpose and appropriate use of DSM-IV in diagnosing mental illness.” That is a stunningly vague statement, and it is offensive to make that statement after you have read of the horrendous suffering described by the complainants as resulting from the use of DSM-IV. For you to make that statement in fact is yet another example, beyond the huge number cited in the complaints, of those in the APA who ought to act to prevent harm from your manufactured products actually turning icily away from evidence of harm and claiming it is not their fault. We remind you, as you wrote in your own materials about the APA’s ethics, that the purpose of having and enforcing ethical rules is to reduce the frequency of unethical conduct. We request that you instead explain specifically and precisely what you mean by your statement.

(5)If you have a look at your own published guidelines and procedures for complaints (at the place cited here above), you will note that you made a serious error in your October 22 statement that since we “filed these complaints with the APA Ethics Committee rather than with a district branch, there is no further appeal from this Committee’s unanimous decision and these cases are closed.” In fact, your own guidelines (Section A.3.c) shall be addressed to the district branch of the accused member, but as you know, there were a great many accused members named in our complaints, and they reside in a great many of your districts. Your section A.3.c clearly allows for the filing of complaints with the APA rather than a district branch, because it specifies that “If [the complaint is] addressed to the APA, the complaint shall be referred by the APA to the Accused Member’s DB.” As you will recall, because the Accused Members (we called them respondents) reside in so many different districts, and also since the matters addressed in our complaints are of national and even national import, we requested that our complaints be heard at the national level. Ms. Coyle claimed in a letter that in order to be “fair,” you would not want to use procedures that differed in any way from anything you have done in the past. I pointed out to her that had the United States judicial system used that kind of rationale, slavery would still be legal here, and neither she nor I would be allowed to vote. You will recall further that when it appeared that you were looking for ways to dismiss the complaints without considering their merits and were wanting to use the argument about the district branch for that purpose, we explicitly asked that you not use a decision to reject any part or parts of our requests in order to justify dismissing each complaint in its entirety. That, however, is exactly what you did. We request accordingly to know (A)whether any complaint has ever been filed with your Committee that involved members of more than one district branch, and if so, how you handled that; and (B)what you offer as justification for using the district branch argument for summarily dismissing every complaint in its entirety. You could, after all, have assigned each complaint to a district branch where the largest number of Accused Members resides, and of course you could have acknowledged that these were matters of more than district import and had them considered at the national level. To do so — and of course it is still not too late to do so, given that your invisible, protected committee members have all the power they want to take upon themselves — would still have allowed you to make whatever findings you wanted about the merits of each complaint. But to make twisted arguments about procedures, ignoring the complainants’ requests that even if you decided not to hear them at the national level, reveals in yet another deeply troubling way how little you care about the suffering your products cause. It also reveals the serious dangers of allowing a lobby group like the APA to operate unregulated.

(6) I have twice requested a time and date the week of November 5 to meet with anyone from your Ethics Committee or Ethics Department. I would appreciate the courtesy of a reply with an appointment time. At this point, my November 5 schedule is full, but I can arrange to come to your office and meet with you any other day that week.

Paula J. Caplan Ph.D.

As of today, they have not responded to these questions, and it seems unlikely that they will. Given that the APA is totally unregulated, why should they respond, unless they cared about the people they hurt and genuinely wanted to hew to important ethical standards.

Other Actions Taken

A week before the complaints were dismissed, I had emailed Linda Hughes and the APA’s General Counsel Colleen Coyle, asking to meet with them in person during my then-upcoming trip to Washington, D.C. I wrote:
…what time on either November 6, 7, 8, or 9 would the two of you be willing to make yourselves available to meet with me at APA headquarters? Perhaps we can make more headway by talking in person than has been made so far. I am sure that you are as eager to get these matters dealt with as are those who have been harmed and who understandably feel that the APA is treating them as though they simply do not matter.

They have not responded to any of my requests for such a meeting.

On October 29, I emailed the current APA President, Dr. Dilip Jeste, who is publicly listed as based in San Diego, to ask for a time to meet with him to discuss some questions I have about the APA, and on November 14 I resent the message. I have not received a reply.

Now I shall describe what four of us did on November 13 in the building that houses APA headquarters in Arlington, Virginia. The aims were twofold: (1)to appear in person to request a meeting, since they had ignored repeated emails in which I had made that request; and (2)to deliver a document (one page on ordinary printer paper) called The Need and The 9 Demands. The demands were some of the actions requested in the complaints, and of course the APA could – if it cared enough to do so – take these actions despite dismissing the complaints. Here is the document:


Untold numbers of people will suffer harm from DSM-IV-TR between now and the time that DSM-5 is published, and then the DSM-5 will cause harm, and the American Psychiatric Association knows that. We demand that the APA act to stop the harm, preventing future harm and redressing harm already caused.


1. announce that past editions of the DSM and the one scheduled for 2013 publication have almost no grounding in high-quality science, that use of DSM labels has not been shown to reduce human suffering and in fact often masks the real causes of suffering, and that their use is highly subjective and can cause a vast array of kinds of harm. This announcement should be issued as a press release and be published in every APA outlet, as well as sent to the heads of every mental health and related organization and training program, the Department of Health and Human Services, and the military and Veterans Affairs mental health departments.

2. develop other ways to make widely known to the public and to professionals the serious limitations of the DSM’s scientific basis, including the poor reliability and lack of predictive and other kinds of validity, and the risks of harm that getting a DSM diagnosis can carry.

3. send an official letter to all training programs for psychiatrists and indeed all medical doctors—since many non-psychiatrist physicians also use psychiatric diagnosis, as well as the American Medical Association, and the Association of American Medical Colleges (AAMC), urging them to require all medical students to be intensively trained in thinking critically about research in general and about research about psychiatric diagnosis in particular.

4. set aside a significant portion of the enormous monetary profits from the DSM-IV and DSM-IV-TR for APA-funded programs aimed to undo harm already done and programs aimed to prevent future harm. The APA as an entity, as well as the current president and trustees, should immediately begin collecting information about who has been harmed and the nature and extent of the harm, and then begin to redress that harm.

5. disseminate widely such warnings as: … our diagnostic classification is the result of historical accretion and at times even accident without a sufficient underlying system or scientific necessity. The rules for entry have varied over time and have rarely been very rigorous.  There is no scientifically proven, single right way to diagnose any mental disorder—and don’t let any expert tell you that there is. [2]

6. post Black Box warnings on every DSM and DSM-related product and in advertisements of every kind related to the manual both currently and in the future, these warnings to include the statement that the products are not grounded in high-quality science, are not reliable or valid and thus have no predictive validity, and can be hazardous to the health and well-being of the persons to whom the diagnostic labels are applied. This might include the following description of the process by which the manual is compiled: ”DSM-IV is the natural outcome of what is essentially a process of discussion and debate within a sociopolitical context. In the absence of more powerful scientific foundations, this was and is inevitable… very few of the hundreds of diagnostic categories have been satisfactorily validated according to these criteria.” [3]

7. compile and distribute at no cost within the U.S. and internationally curriculum materials for teaching psychiatrists, residents, interns, and others in the mental health field how to minimize the harm from diagnosis, including but not limited to stating in the patient’s chart and in a letter to the patient that whatever diagnoses they were given are not scientifically grounded and cannot legitimately be assumed to shed light on the patient’s ability to be a good employee or parent or to make decisions about their medical and legal affairs.

8. convene public hearings within six months of today’s date, these hearings to be about the subject of harm that those given DSM-IV and DSM-IV-TR diagnoses have experienced as a result of receiving those labels, and hold annual hearings after the DSM-5 is published.

9.  ensure that beginning with the APA’s 2013 convention, at every annual convention, those who have been harmed as a result of being given DSM labels be impaneled as speakers in a series of presentations about these kinds of harm.

[2] Frances & Widiger (2012).
[3] Guze, Samuel. (1995). Review of DSM-IV. The American Journal of Psychiatry 152.

I will describe the events of November 13 and ask you to consider that, whatever went on behind the scenes in the APA office – and it might be that they were on alert because of my error in copying Linda Hughes in when I mentioned a November 12 action in that email – not one thing I have ever done with regard to the DSM has involved anything violent or destructive or threatening … except insofar as speaking the truth strikes them as violent, destructive, or threatening. So if they were on alert in some way, what was that alert about? Not wanting to be held accountable for ignoring the harm they do, it seems.

Weeks before November 13, I contacted two Virginia lawyers, telling them what we planned to do, saying there would probably be only a few of us, and asking about Virginia law with regard to videotaping and/or audiotaping people in privately-owned space. These discussions only strengthened my view that we would try to record whatever transpired but would turn off the recording device(s) if asked to do so and would depart if asked to do so. This was not intended to be an action that would result in our arrests, just a civil request for an appointment and an opportunity to deliver copies of the Need and 9 Demands in person to Hughes and Coyle or anyone in authority who might be acknowledged to be in the office that day.

It was important for Jenny McClendon to be there, because she is one of the complainants, because it was the day after Veterans Day (the APA was closed on Veterans Day, or we would have gone then), and up to that point, no one in authority in the APA had had to look upon the face of one of the complainants and know how the DSM had tragically harmed them. In addition to the two of us, activist and videographer Leah Harris kindly agreed to attend and bring her videocamera, and social worker Debra Turkat also attended for backup filming and to be a fourth witness to whatever would transpire.

If I had it to do over again, I would have gone to the site before November 13 to learn the physical layout and to make plans for what to do in the event of inclement weather. The weather turned out to matter a lot. The reason was that, wanting the events to be filmed in the order in which they actually occurred, I had asked that we meet outside the complex of buildings that houses the APA on one upper floor. The plan was to have Leah record what we were about to do and why, then unscroll a 24 X 33-inch, laminated version of the Need and 9 Demands, and read them aloud. Then we were going to head up to the APA office.

The morning of November 13 was cold and rainy. We decided to meet in a coffeeshop within the 1000 Wilson Blvd. complex of shops and offices. Around 10:30 a.m., I thought I should dart up to the APA floor and see whether we would need to be buzzed in through a locked door or would be able to go right into the office, so that Leah and Debra would have a sense of where they could stand to do the filming. The walls of the building complex are made largely of glass, and at one end of a long hallway, I saw two men standing at the concierge desk. Next to them was a directory listing the APA in “2000.” The concierges and I chatted amiably for a minute, and I asked if 2000, the APA office, was on the second floor. No, it’s on the 20th floor, they said, pointing toward two sets of elevators, one of the men saying, “Don’t take those elevators [on the left]. Take the ones over there [on the right].” No sign-in book, no visitors’ badges were visible, and they did not ask me who I was. I got in the elevator, which numerous other people entered at the same time, some wearing badges, some not, but no one stopped or questioned by the concierges.

When the elevator door opened on the 20th floor, I saw that the APA appears to occupy the entire floor. To my right I saw a door that bore a sign “Health and Wellness Week.” Behind that partly open door I saw people exercising. I needed to throw away a food wrapper, so I walked about 15 feet past the door to a trash can. As I got to the trash can, I heard a voice not inquire politely but demand, “May I help you?” I turned and headed back to the elevator, and as I did so, the man who had spoken, a tall fellow wearing some sort of ID card, came within inches of me and repeat his question, this time more urgently. I smiled and continued the short walk back to the elevator, saying, “No, thank you. I’m supposed to meet somebody, but she’s probably downstairs.”

Back at the coffeeshop, we decided to do the pre-APA filming in the hallway, which was filled with natural light. If we went very far from the concierge’s desk, there was too much noise, so about 30 feet from that desk, on camera, Jenny and I began our planned explanation of where we were and what we were going to do. Then we unfurled the large version of the Need and 9 Demands document and began to read it aloud. When we got about two-thirds of the way through it, a security guard approached us and told us that we could not film there, because the building is privately owned. I told him we would stop the filming immediately. I asked who owns the building, and he said “Monday,” pointing to the logo on a door near the concierge’s desk. (A later internet search shows that Monday Properties Securities owns it.) I asked whether it was Monday’s or the APA’s rule that no filming could be done in the hallway, and he said, “Both.”

In a nonconfrontational conversation, I told him that we would do no further filming but had a document to deliver to the APA office. He asked to whom we wanted to deliver it, and I said, “Linda Hughes in the Ethics Department and Colleen Coyle, the General Counsel.” He asked if I had been in touch with them, and I replied that we had been emailing each other for some months. He asked if I had a phone number for them, and I said that I did and started to look it up on my phone. While I did that, he smiled and said that he just needed the number so he could be sure that I had in fact been in touch with them. But when I gave him the number, he dialed it and walked some distance away. As he did that, I also dialed it but did not expect anyone to answer, since every time I have tried to phone there, I have been automatically on hold for 20 or so minutes and have usually hung up. Soon, several other people, including others dressed in security guard uniforms and a woman in brightly-colored business attire (was she from the security company or APA?) were conferring with “our” guard nearby. Then the guard who had told us to stop filming came over and said we would have to leave, because he had checked with the APA and been told that neither Hughes nor Coyle was in. I said in that case it would be fine if we can just leave the printed material we had brought for them, and he again refused. I asked if we could ask to meet with someone else in the APA, and he said we could not. He had also been told that we did not have an appointment upstairs. At that point, I introduced Jenny, briefly told him her story, said she was one of nine people harmed by the diagnostic handbook the APA produces who had filed ethics complaints with the APA, that the APA had dismissed them, and that they had repeatedly ignored our requests just to meet with them. I suggested that we leave the documents with the concierge for Hughes and Coyle, and he said the concierge is part of the security for the building and is not allowed to accept documents. We asked if security is always this tight, and he said that it is. I would love, though, to find out if anyone else trying to leave a document for anyone at the APA or any other office in the building would be refused.

Jenny, speaking gently but matter-of-factly, said to the guard with whom we were dealing that she wanted to point out that she can walk into her Congressman’s office any time and that that was totally different from her experience trying to go up just to ask the APA ethics people for an appointment.

Throughout everything described above, I was aware that the woman standing at the concierge position rarely even looked up. People with and without badges were walking right past her and heading to the various elevators without being stopped or even noticed.

Two guards escorted us to the elevators, and as they did so. I told both of them we understood that they have rules they have to follow and thanked them for being gracious to us. I explained to the first guard what the DSM is and that it has hurt many people, including in ways that are racist, sexist, and classist. I introduced myself and said that my work involves trying to reduce some of that harm, and I gave him the address in case he might know of anyone who needs that kind of help.

Someone who heard this story and knows ins and outs of security practices speculated that people in the APA office may have been able to see us through videocameras in the building. I am not used to thinking along those lines, but anything is possible.

Is the APA always so vigilant about keeping people without prearranged appointments from even appearing in their reception area? Were they on guard because of the email I had mistakenly copied to them? Because I, a 5’1” woman with white hair and not wearing an APA ID badge had appeared in their office space for about 20 seconds a few minutes before? Because they had read the November 11 essay I posted and seen at the end of it or under How You Can Help at where people were urged to contact Hughes, Coyle, and the APA president to ask them to overturn the dismissals.

Whatever the reason or reasons for APA’s refusal even to let us come upstairs, these latest events are just more evidence of their lack of care and concern for those for whom the DSM was the “first cause” of so much suffering.

After reading a draft of this essay, survivor movement activist Amy Smith wrote to me:
It is worse, much worse, than I had imagined it could be.  It truly reads like a bad dream, a descent into the bowels of the beast (even though it was on the 20th floor!).   …how arrogant, paranoid and cold they are.  I’ll tell you, if I or any of my friends behaved in such a manner, you can believe we would be immediately smacked with multiple labels from the DSM ourselves.

It is easy to forget that at some level, some people at the APA must surely care about the harm they do. So on November 14, I sent the following email, with the Need and 9 Demands document attached, to Linda Hughes and Colleen Coyle:

Hello, Linda and Colleen,

You are no doubt aware that Professor Jenny McClendon, who is the military veteran who filed one of the complaints you dismissed, and I came with two other people yesterday to deliver the attached document to you.

You will see in this Need and 9 Demands some of the actions the complainants had requested of you. The APA could take these actions despite having dismissed the complaints. To act on even one of these demands would be to give the first indication in this entire process that the APA has any interest in redressing past harm and preventing future harm from your diagnostic manual.

In vain have we searched your communications — and failures to communicate — for signs of concern about the human beings your organization’s product and the respondents’ actions and inactions have harmed. It would have been in the APA’s interest and your interest as APA employees if you had allowed us to meet with you yesterday, for once you meet one of the complainants in person, you will find it harder to disrespect them, harder to act as though they do not deserve an adequate, reparative response. Linda and Colleen, your concern for the suffering of others, which one tends to believe must reside in the hearts of most people, must surely have plagued you as you have carried out the wishes of your bosses at the APA. Their wishes must be hard to reconcile with compassion and empathy.

I speak for all nine complainants when I say that we do not assume that you are bad people but that it seems that, like pilots of drones who send death to people thousands of miles from where they press the buttons, you can only do your work by acting as though your targets are less than human. When the humanness of the drones’ targets breaks through to the pilots, they crack. We hope that for your sakes and the sakes of the complainants and the countless others your organization harms, you will confront their humanity, ask the Ethics Committee to reverse its dismissals, and give the complainants’ suffering the respect and consideration that you must know they deserve.


How You Can Help: Time for Action that Anyone Can Take

Because no one regulates psychiatric diagnosis, the APA is a fortress that has been impervious to the authors of the many books and articles who have pointed out its unscientific, unhelpful, and often harmful nature. It has been impervious to the kind of activism organized by MindFreedom International and PsychRights at the May 5 2012, APA convention (they called it “5/5 Against DSM-5”) and to the petition I started that garnered individual signatures and organizational support representing six million people in the late 1980s and the recent one organized by Dr. David Elkins to which many groups and about 12,000 individuals signed on.

It is way past time to ask them to change and high time to take action. The only routes that seem likely to lead to real change are massive public education through the media and lawsuits. I have been trying for decades to find lawyers who both grasp the importance of these matters and are in a position to do the work pro bono. But everyone reading this essay can do any or all of the following:

(A) [This was included in the November 11 essay at Grassroots Group to End Harm from Psychiatric Diagnosis, whose website is — where many stories of harm from diagnosis of civilians as well can be read — has a suggestion for people who are troubled by the APA’s failure to take action to redress the harm to the complainants or to prevent harm to others. They urge concerned citizens to ask the APA to overturn its summary dismissal of the complaints and instead give serious consideration to their merits by doing any or all of the following:
emailing Linda Hughes, who is apparently the head administrator in the APA’s Ethics Department (the names of the psychiatrists who make up the Ethics Committee that is tasked with reviewing complaints were not disclosed to the complainants, despite their repeated requests), Colleen Coyle, the APA’s General Counsel, and current APA President Dilip Jeste at “Linda Hughes” , “Colleen Coyle” , and; and
making the same requests to them by telephone at 703-907-7300 (for Hughes and Coyle) and at 858-534-4020 for Jeste).

I hope that readers here will consider sending those emails and making those calls.

(B)We are working on a variety of ways to spread the word about the APA’s inhumanity to the complainants (and countless others). One of these ways is a series of videos of the complainants’ stories, which will be posted in the near future on YouTube under the collective title, “Watch the Stories of Harm the APA Refused to Hear.” The introductory one with my overview about the complaints and their dismissal is up now at Please view this video, email and post the link everywhere you can, and check YouTube periodically under “Watch the Stories of Harm the APA Refused to Hear” to see the complainants’ stories.

(C) Consider joining the Facebook page called Stop Psychiatric Diagnosis Harm, where these kinds of matters are regularly discussed.

(D) Please post widely both this essay and its predecessor, which is at, as well as the November 11 essay, which is at

(E) If you want to help or have other suggestions for actions, please get in touch through the Contact form at

(F) Know that we are exploring a variety of other kinds of action and will make them publicly known as we proceed, including at

Reflections on Alternatives 2012

by Ruminations on Madness

Two weeks ago (three?) I was in (‘weird’ & beautiful) Portland, Oregon, for the 2012 Alternatives conference.  Due to subsequent travels, I didn’t have a chance to actually type up my notes (select themes & highlights) until today. Here they are:

(1) “Peers.”

Many of my richest conversations took place, one on one, with coffee or a glass of wine, outside of the conference’s formal sessions and institutes.  A surprising number of these discussions eventually turned to the question or problem of how to define the boundaries of a “peer” (increasingly, I think, the preferred term for consumer/user/survivors—a trend, I’ve  heard from friends in Canada, that also seems to hold north of the border).  I’ve mentioned some of the controversies around this issue before, and many of the concerns I heard in Portland were unsurprising:  how to square, for example, the fact that the majority of the American population now receives some form of psychiatric drug (if not a formal Axis 1 diagnosis), while others navigate mental states they understand as forms of “madness” without any formal involvement with the mental health system.   The privileged role of (only certain) ‘lived’ experiences in the context of peer-provided services also came up repeatedly. A non-user female therapist with personal experience of rape, as one of my interlocutors pointed out, might be far better ‘matched’ with a rape survivor (with a label of schizophrenia) than a male therapist with lived experience of psychosis but no experience of trauma or sexual assault.  Provocatively, this (over)emphasis on (or even fetishization of) particular experiences or (psychiatric) labels but not others (non-traditionally psychiatric labels or identities) seems to unwittingly reflect and even reinforce the very diagnostic system (and clinical service boundaries) many activists otherwise work to unsettle or overturn.  Still others mentioned concerns about “co-opted” peers whose ‘recovery stories’ emphasize the “permanence” of medically-defined brain-based psychiatric disorder(s) and the need for lifelong medications. (“Sometimes the non-user providers are far more progressive than the peer providers, what do we do about that?…”)

On the other hand, most of the individuals I talked with seemed (simultaneously) acutely (almost painfully) aware of the (sometimes substantial) sociopolitical advantages of “peer-only” positions, including the career opportunities they create for financially disenfranchised service users, the clinicopolitical import of publicly troubling the boundaries between ‘clinician’ and ‘patient,’ the historical significance of peer-led services qua the ‘fruition’ of a (the?) central goal of the early c/s/x movement, and the (sometimes) extraordinary & incomparable insights of “guides” with lived experience of various forms of madness.  (I was certainly witness to the latter in a fantastic and inspiring Alternatives ‘institute’ I attended on peer-run alternative crisis respites.)

What to do?  No one I talked to seemed certain, but their (almost ubiquitous) willingness to question the boundaries of identity without any immediate solution or answer, impressed me very deeply.

(2) Generational issues

Another common theme revolved around various generational tensions within the US peer movement.  Sally Zinman, for instance, kicked off the first full-day with a rousing, but also internally troubled history of early c/s/x organizing.  Although she acknowledged that, back in the day, “a SAMSHA funded conference would have been unthinkable” and emphasized the almost paradigmatic shift from the radical separatism of the 60s and 70s to cooperation and collaboration with “the feds and the system” (beginning in approximately the mid 80s), the (many) lingering controversies of this shift—and the resulting splintering of groups and c/s/x values—went noticeably undiscussed. Outside sessions, the younger (40 and under) attendees I talked to expressed a variety of opinions regarding generational differences within the movement (and at Alternatives), ranging from concerns with the extent to which older activists have “sold out” to the feeling that (conversely) many older activists don’t understand how much mental services have improved. One of my interlocutors, for instance, emphasized how grateful he was to his providers (& even psychiatrist) and located the primary source of his negative experiences outside the mental health system–in work, school and the community.  (Certainly my personal experiences in academia have been far worse than in the mental health system….)

(3) Research and the US peer movement

Unsurprisingly, I also ended up conversing with a number of peer graduate students and/or recent PhDs about more literally “academic” issues.  The rough consensus seemed to be that there was little space for discussing and exploring more “research-oriented” issues at Alternatives; several people independently mentioned the pervasiveness of American “anti-intellectualism” (as evidenced by the conference program and selection of speakers and panels), while another noted that “at Alternatives you need to leave your academic degrees and credentials at the door.” Although I couldn’t make it to Cardiff, the difference between the tracks and panels at the 2012 Hearing Voices Congress–which included many accessible but robust “academic” presentations–and Alternatives, was undeniably striking.

Specific issues regarding identity and generational differences also surfaced in the context of research.  What does (could/should) it mean to identify as a “peer” researcher?  How can younger investigators best navigate the (mixed) “legacies” of first-generation American consumer/survivor researchers?  Of particular interest to me in these conversations was the sometimes sharp mix of advantages and disadvantages different individuals described with respect to disclosure and ‘self-marketing’ as a “peer.”  On the one hand, disclosure can obviously lead to significant uncertainties (& many negative psychological sequelae) regarding the extent to which any accolades or academic invitations are motivated by individuals’ ‘objective’ academic accomplishments, or by tokenism, a need or desire for some sort of moral expiation (on the part of institutions or established researchers), or some (uncomfortable) synthesis of these and other influences. Out in the “real world,” there seem to be several unsettling examples of individuals who were initially elevated to positions that arguably exceeded their actual accomplishments, but ultimately discarded by their institutions or collaborators. Others (I’m consciously avoiding names!) appear to have been catapulted into the role of national spokespersons & “superstar advocates” following late-career disclosures (without having ever previously taken active public roles in the user/survivor movement–presumably due, at least in part, to fears precisely apropos disclosure).  On the other hand, it seems clear that in at least some contexts and settings, experience as a public (“deeply engaged”) activist or advocate (and researcher) can lead to unique and important insights (e.g. with respect to power, appropriate design considerations, research methods, questions, nuances), access to hard-to-reach populations, and more immediate rapport with participants; once again, then, many questions & uncertainties, and no easy answers.

(4) Hearing voices and the exclusion of other ‘mad’ experiences

My conversations about the hearing voices movement were far fewer and here the dominant ‘theme’ seemed to revolve around the problem of of the Hearing Voices Movement’s (arguable?) over-emphasis on voices (over & above other manifestations of ‘madness’), or even (functional or implicit) exclusion of these experiences.  I admittedly do not (but would love to) know what sorts of conversations around these issues have already transpired among user/survivors, voice hearers & allies in the UK.  At the very first public presentation I gave on the hearing voices movement here in Chicago, several users came up afterwards and expressed concerns that (1) they experienced “delusions” or mania but not voices (or a strongly intertwined combination), and therefore did not feel included by my presentation or (2) hear voices but explicitly didn’t want to isolate voice hearing from their other experiences (including not only other types of ‘psychotic’ phenomena, but also depression and anxiety). In subsequent presentations, clinicians have expressed parallel concerns.  This is certainly an issue I need to think more about as Chicago Hearing Voices develops—any input/thoughts would be most welcome!